Pickleball-Related Eye Injuries
Pickleball-related eye injuries are on the rise due to the sport’s rapid growth in the United States, especially among adults aged 50 and older
Botox use in Face and Head
Botulinum toxin (BoNT) acts by:
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Presynaptic inhibition at neuromuscular junctions → blocks acetylcholine (ACh) release
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Cleaves SNARE proteins (SNAP-25, VAMP, syntaxin) → prevents vesicle fusion
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Effects last 3-6 months (until nerve terminals regenerate)
A. Chronic Migraine
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Injection Sites: 31-39 sites across frontal, temporal, occipital, and cervical muscles
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Dose: 155-195 units (Botox®) q12 weeks
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Efficacy: ~50% reduction in headache days/month
B. Spasticity (Post-Stroke, CP, MS)
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Targets: Gastrocnemius (foot drop), biceps (flexor spasticity), adductors
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Dose: 50-400 units per muscle (individualized)
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Combines with PT/OT for best outcomes
C. Dystonia
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Cervical dystonia (torticollis): Sternocleidomastoid, splenius capitis
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Blepharospasm: Orbicularis oculi
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Writer’s cramp: Forearm flexors
D. Hyperhidrosis (Excessive Sweating)
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Palmar/axillary: 50-100 units per area
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Effect: Anhidrosis for 4-12 months
OFF Label Use
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Trigeminal Neuralgia (masseter/temporalis injections)
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Neurogenic Detrusor Overactivity (bladder injections)
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Tremor (refractory essential tremor, dystonic tremor)
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Bruxism (masseter injections)
4. Practical Considerations
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Peak Effect: 2-4 weeks post-injection
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Adverse Effects:
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Local weakness (e.g., ptosis in blepharospasm)
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Dysphagia (if neck muscles injected)
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Dry mouth (migraine protocol)
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Contraindications:
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Myasthenia gravis, ALS, Lambert-Eaton syndrome
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Allergy to BoNT components
5. Future Directions
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Newer Toxins: IncobotulinumtoxinA (longer duration)
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Non-motor Applications: Depression (facial feedback hypothesis), neuropathic pain
Source: A.R. Yassin, MD
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